RAVEN  Records  And  Verifica1on  

Electronic  Network  

Karl  Powers,  Chief  Informa1on  Officer  Patricia  Smith,  Pa1ent  Care  Services  Administrator  

Ellen  Hodges,  MD,  Chief  of  Staff  

 

What  is  RAVEN?  

•  RAVEN  is  YKHC’s  new  electronic  health  record  

•  The  RAVEN  “Go  Live”  was  January  28,  2013    

•  It  is  in  use  at  every  village  clinic  and  SRC    

Why  is  it  Important?  

•  Improved  Care  

•  Pa1ent  Safety  

•  Real-­‐Time  Data  

•  Privacy    

How  did  it  go?  

•  Staff  are  adap1ng  to  RAVEN  and  becoming  more  proficient  

•  Addi1onal  training  as  needed  

•  Improvements  to  RAVEN  as  needed  

What’s  Next?  

•  Down  Time  P&P  

•  Meaningful  Use  

•  New  Projects  – Pa1ent  Portal  expected  October  2013  

Go-­‐Live  Bethel  Outpa1ent  Clinic  

•  Increased  outpa1ent  clinic  appointments  from  20  minutes  to  40  minutes  from  1/28/13  –  2/28/13  

•  Extended  Clinic  hours  to  8pm  •  Held  Saturday  clinic  each  Saturday  for  first  month  also  opened  clinic  on  President’s  Day  2/18/13  

•  Maintained  adequate  number  of  providers  in  outpa1ent  clinic  each  day  

•  Maintained  1  provider  for  RMT  in  the  morning  and  3  providers  for  RMT  each  adernoon  

Go-­‐Live  Pa1ent  Care  Services  

•  Added  full  service  for  extended  clinic  hours  and  Saturday  clinics  –  Imaging  

•  Mammography  and  Ultrasound  

– Pharmacy  •  Full  service  for  prescrip1ons  

– Laboratory  •  Full  services  for  specimen  collec1on  and  processing  

Go-­‐Live  ER/  Inpa1ent  

•  Added  a  Pediatrician  to  the  ER  from  3pm  –  11pm  each  day  

•  Added  an  addi1onal  Physician  to  the  Inpa1ent  services  for  the  week  of  go-­‐live  

•  Bumped  up  Fast  Track  to  open  at  3pm  instead  of  5pm  

•  Added  an  extra  RN  to  each  shid  temporarily  to  assist  

Go-­‐Live  Sub-­‐Regional  Clinics  

•  Increased  clinic  appointment  from  30  to  60  minutes  from  1/28  -­‐3/4  

•  Increased  providers  that  were  available  at  each  site  to  see  pa1ents  

•  Started  village  travel  and  specialty  travel  week  of  2/4  

•  Ensured  pa1ents  were  seen  within  3  days  of  request  

Go-­‐Live  Village  Clinics  

•  Video  Teleconferences  held  the  week  prior  to  Go-­‐Live  with  each  clinic  advising  staff  to  – Explain  the  new  process  to  community  – Prepare  for  backlog  of  pa1ents,  handling  difficult  situa1ons  

– Review  support  available  – Encourage  using  all  resources  

Go-­‐Live  Village  Clinics  •  8  Float  CHA/Ps  in  field  +  all  Back  Up  Health  Aides  and  Office  Assistants  approved  to  work  

•  16  Super  Users  trained  from  larger,  busier  clinics  for  onsite  help  

•  Increased  individual  pa1ent  appointment  1mes  to  up  to  2  hours  for  first  day  of  Go-­‐Live  

•  Some  clinic  hours  extended    

Go-­‐Live  Village  Clinics  •  Call  Center  implemented  at  the  Health  Aide  Training  Center:  – 10  Instructor-­‐experts  assis1ng  Health  Aides  over  phone  and  via  computer  

– Staffed  8am-­‐7pm  first  two  weeks  – Aderhours  On-­‐Call  phone  support  (on-­‐going)  

•  VO  Registra1on  Call  Center  helped        Office  Assistants  w/registra1on  

RAVEN  Data  

•  When  a  pa1ent  is  seen  in  a  village  clinic  or  SRC,  the  Health  Aide  enters  the  informa1on  into  RAVEN.  

•  This  informa1on  is  then  reviewed  by  Bethel  or  SRC  providers  for  RMT  (Radio  Medical  Traffic)  

•  The  visit  informa1on  is  immediately  available  for  anyone  with  access  to  that  pa1ent’s  chart  

Katrina  Crane,  CHA  II,  uses  RAVEN  

RAVEN  Data  

•  The  notes  are  complete  and  readable  •  The  Health  Aides  also  have  access  to  all  the  things  that  happened  in  Bethel  or  in  an  SRC  

•  Complete  record  of  all  things  that  happened  to  the  pa1ent  in  one  place  

•  Mul1ple  providers  can  view  chart  at  the  same  1me.  

RAVEN  Data  

•  Pa1ents  presen1ng  to  the  ER  with  complete  history  – Village  Clinic  Notes  – All  previous  visit  notes  

•  This  allows  a  complete  evalua1on  of  the  pa1ent  without  any  missing  visit  informa1on.  

TEST  pa1ent  summary  

RAVEN  Data  

•  Meaningful  use  indicators  •  Not  enough  just  to  buy  and  implement  an  electronic  health  record  

•  Also  must  prove  that  you  are  using  it  in  a  way  that  improves  the  pa1ent  experience  in  the  hospital  system  

RAVEN  Data  

•  The  Affordable  Care  Act  required  implementa1on  of  an  electronic  health  record  in  order  to  maintain  funding  from  Medicare  and  Medicaid  

RAVEN  Data  

•  The  board  of  directors  directed  us  to  explore  all  op1ons  for  an  electronic  health  record  

•  RPMS  was  “free”  but  clinical  staff  felt  strongly  that  this  would  not  meet  our  clinical  needs  

•  A  process  that  took  over  2  years  was  undertaken  

RAVEN  Data  

•  Cerner  was  the  company  chosen  – High  quality  product  – Excellent  support  

•  Gives  our  pa;ents  the  high  quality  product  that  could  be  implemented  safely  in  all  villages  

Meaningful  Use  Summary  

03  28  2013   YKHC  MU  Summary   26

14 Hospital Core Requirements Name Target

CPOE for Medication Orders >30% Drug Interaction Checks Y/N Maintain Problem List >80% Active Medication List >80% Medication Allergy List >80% Record Demographics >50% Record Vital Signs >50% Record Smoking Status >50%

Clinical Decision Support Rule Y/N  Electronic Copy of Health Information >50% Electronic Copy of Discharge Instructions >50% Electronic Exchange of Clinical Information Y/N  Protect Electronic Health Information Y/N  

Meaningful  Use  Summary  

03  28  2013   YKHC  MU  Summary   27

• Where  we  are  now  •  Hospital  Status  as  of  03  21  13  

Current  Percentage   Target  

CPOE  for  medica1on  orders   93   30  

Maintain  ac1ve  medica1on  allergy  list   97.6   80  

Maintain  ac1ve  medica1on  list   90.9   80  

Perform  medica1on  reconcilia1on   83.5   50  

RAVEN  Data  

•  All  of  the  pa;ents  medica;ons  are  in  one  place  accessible  to  everyone  who  needs  to  review  the  list  

•  Also  a  complete  list  of  the  medica;ons  that  were  given  to  the  pa;ent  during  a  course  of  treatment  

RAVEN  Data  

•  Prescrip;ons  are  now  legible  and  complete  

Prescrip1on  in  RAVEN  

RAVEN  Data  

•  Can’t  prescribe  a  medica1on  if  the  pa1ent  has  an  allergy  

•  Drug  interac1ons  are  checked  and  the  provider  is  informed  of  them  at  the  1me  of  the  prescrip1on